We all carry with us reminders of the person we used to be. It’s just a lot more literal for some than others. People who lose a massive amount of weight are often surprised at how unhappy they still are with their bodies. The fat is gone, but all that skin that held it in place? It didn’t go anywhere.

It’s a less explored part of extreme weight loss. The body may be lighter, but it’s now weighed down with folds of sagging skin, causing a wild amount of emotional and physical (think: chafing) pain.

More extreme weight-loss patients are choosing to remove the loose skin through cosmetic surgery, and a recent study showed that the bodies and minds of those who do end up faring much better.